Medication errors are one of the most prevalent patient safety issues in long term care facility quality. The widespread adoption of electronic prescribing systems and electronic medication administration records (eMAR) has opened the door for the development and deployment of new technologies to address errors occurring in the administration of medications. IdentRx is a novel bench top system capable of determining the composition and dosage of individual pills, tablets and capsules in real-time. To ensure medications are delivered to the correct patient, verified pills are placed into a locked medicatio carrier that opens only when physically brought to the correct patient and passed within a few inches of a patient's wrist band that contains an RFID tag. We propose to implement, test and evaluate the IdentRx system for medication administration and charting in nursing homes. We hypothesize that the IdentRx system will reduce both medication administration errors and charting errors in the nursing home setting. Phase 1 - Pilot Integration, Implementation and Testing of IdentRx in a Nursing Home: The pilot will allow the implementation team to fully test the functionality, integration and usability of the new system in a real life environment. Objectives include: (1) Build the IdentRx database to encompass the approximately 3,000 medications on the nursing home formulary. (2) Demonstrate accuracy of IdentRx in pill identification. (3) Interface IdentRx with the eMAR system in use at the long term care facility. (4) Integrate IdentRx with RFID wristband system at the long term care facility (5) Conduct a focus group at the nursing home and on-site workflow observations of medication administration staff to understand medication administration processes. (6) Design user interface and industrial design, and manufacture the IdentRx System and Medication Carriers. (7) Pilot IdentRx and Medication Carriers at the long term care facility. Phase 2 - A Randomized Controlled Trial to Evaluate the Impact of IdentRx on Medication Administration Errors and Workflow in a Nursing Home: We will perform a cluster randomized controlled trial evaluating the impact of IdentRx on the incidence of medication administration and charting errors and workflow in a nursing home. Four patient care units at the nursing facility will be randomized 50:50 to either the IdentRx System (intervention units) or control units. The study's Primary Outcome measure is the rate of medication administration errors and the rate of charting errors in both the intervention and control units. Our goal is to achieve a reduction of >45% in serious medication errors. A secondary outcome is the incidence of potential adverse drug events. A physician panel will rate the severity of each medication administration error to determine whether it has the potential to cause patient harm. Another secondary outcome is to assess the Impact of IdentRx on the workflow of the medication administration staff. The impact of the IdentRx system on nursing efficiency will be measured by performing time-motion studies through direct observation of staff in the intervention and control units.